East of England research shows benefit of helping ED attendees to quit smoking

Giving out free e-cigarette starter packs in hospital emergency departments to people who smoke helps more people quit – according to research from the University of East Anglia (UEA) and the Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH).

The trial offered advice, an e-cigarette starter pack and referral to stop smoking services to people attending ED for any reason, to help them to stop smoking.

Six months later, almost one in four people given the starter packs said they had quit smoking. And those who received the packs but didn’t quit altogether, were more likely to have reduced the number of cigarettes they smoked.

The trial took place across six UK hospitals, including the NNUH's Emergency Department, and the research team now hope that the initiative will be rolled out to hospitals nation-wide.

It was funded by the National Institute for Health and Care Research’s (NIHR) Health Technology Assessment (HTA) Programme and was run by the Norwich Clinical Trials Unit at UEA.

Dr Ian Pope, from UEA’s Norwich Medical School and emergency physician at NNUH, said: “Emergency departments in England see more than 24 million people each year of whom around a quarter are current smokers. Attending the emergency department offers a valuable opportunity for people to be supported to quit smoking, which will improve their chances of recovery from whatever has brought them to hospital, and also prevent future illness.

“Smoking killed almost 75,000 people in the UK in 2019 and it is the leading cause of preventable death and disease in the UK. Swapping to e-cigarettes could save thousands of lives. We believe that if this intervention was widely implemented it could result in more than 22,000 extra people quitting smoking each year.”

The study, co-designed and managed with the help of Norwich Clinical Trials Unit, ran over 30 months across six hospitals in England and Scotland – at NNUH, the Royal London Hospital and Homerton University Hospital in London, Leicester Royal Infirmary, Addenbrooke’s hospital in Cambridge and the Royal Infirmary of Edinburgh.

A total of 972 people who smoked who agreed to take part were randomly assigned to receive either smoking advice, an e-cigarette starter pack and referral to local stop smoking services - or just ‘usual care’ written information about locally available stop smoking services.

Both groups of patients were asked if they were still smoking one, three and six months after they attended hospital. Those who reported quitting after six months were asked to undergo a carbon monoxide breath test.

Dr Pope said: “Those recruited were from neighbourhoods with high levels of deprivation and more people were unemployed or unable to work due to sickness or disability than the average.

“23.4 per cent of the vape intervention group reported having quit smoking six months after they attended the emergency department, compared to 12.9% of the usual care group. This shows that people were twice as likely to quit smoking having received the intervention than not.

“We also found that people who had received the vape intervention but did not quit smoking were more likely to reduce the number of cigarettes they smoked and more likely to have tried to quit compared to the usual care group.

“Based on these results we feel hospital emergency departments are a valuable opportunity to support people to quit smoking and policy makers should seriously consider it as a location for smoking cessation interventions.”

‘Cessation of Smoking Trial in the Emergency Department (COSTED): a multi-centre, randomised controlled trial’ is published in the Emergency Medicine Journal.